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General NPI Number Information
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NPI Number | 1831259571
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Entity Type | Individual
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Provider Name | JENNIFER P PORTER MD
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Gender | Female
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Dates
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Enumeration Date | 12/11/2006
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Last Update Date | 10/14/2015
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Provider Practice Location Address
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Address Line | 7201 WISCONSIN AVE SUITE 515
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City | BETHESDA
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State | MD
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Zip | 20814-4810
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Country | US
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Telephone | 301-652-8191
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Fax |
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Provider Business Mailing Address
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Address Line | 7201 WISCONSIN AVE SUITE 515
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City | BETHESDA
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State | MD
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Zip | 20814-4810
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Country | US
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Telephone | 301-652-8191
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207YS0123X
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Taxonomy Name | Facial Plastic Surgery Physician
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License Number | D0059521
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License Number State | MD
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